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Mina Kim: Welcome to Forum. I’m Mina Kim. Unprecedented changes have come to childhood vaccine recommendations. Health and Human Services Secretary Robert F. Kennedy Jr. announced last week a dramatic reduction in the number of vaccinations recommended for children, saying the decision protects children, respects families, and rebuilds trust in public health. But the move has drawn widespread criticism from public health experts.
Listeners, what do you think? Will the new vaccine guidelines influence your decisions about what shots your children get?
Joining me is Dr. Grace Lee, professor of pediatric infectious diseases at Stanford Medicine and former chair of the Advisory Committee on Immunization Practices, which recommends vaccines for the U.S. population. Dr. Lee, so glad to have you on today.
Dr. Grace Lee: Thank you so much for having me. I appreciate the opportunity.
Mina Kim: Also with us is Maria Godoy, health correspondent for NPR. Welcome, Maria.
And Dr. Lee, let me start with you. Help us understand what’s happened. Can you give us a rundown of what has changed in CDC guidance on childhood vaccinations?
Dr. Grace Lee: Thanks. There are really two types of changes in the CDC’s guidance on childhood vaccination. One is the content of the recommendations, and the second is the process by which scientific recommendations are made.
Let’s start with content. There are eighteen vaccines available in the U.S. to protect children from infectious diseases. Last year at this time, seventeen of those eighteen vaccines were considered universal recommendations — meaning the benefits to U.S. children outweighed the risks.
Today, HHS is directing the CDC to categorize these vaccine recommendations differently. At a high level, eleven out of eighteen available vaccines are now considered “international consensus” vaccines. One is recommended only for high-risk groups. Three are recommended only based on shared clinical decision-making. And three are recommended for both high-risk groups and shared clinical decision-making in children.
So, in essence, the totality of these changes is confusing at best.
Mina Kim: My understanding is that the vaccines the CDC is continuing to recommend include measles, whooping cough, polio, chickenpox, HPV, Hib, and the pneumococcal vaccine. Which vaccines are now being shifted into these other categories — either only for high-risk groups or based on conversations with a doctor?
Dr. Grace Lee: Yes, thank you. You mentioned the eleven vaccines that remain universally recommended — I was trying to count along as you were listing them.
The other vaccines have been moved into high-risk or shared clinical decision-making categories. These are still technically recommendations, but by downgrading them, HHS is implying that there’s limited benefit to getting vaccinated.
What’s missing from the international consensus category is protection against respiratory viral infections, such as RSV, flu, and COVID. We’re also changing or impacting vaccines that prevent cancer, such as hepatitis B and human papillomavirus. We’re missing vaccines for teens that prevent meningococcal disease, which is a serious infection. And we’re missing protection against viruses that cause diarrheal illness and are highly transmissible, such as rotavirus and hepatitis A.
Those are the types of changes that have occurred over the past week.
Mina Kim: And I understand this overhaul is effective almost immediately. What is your understanding of why these recommendations changed? How is HHS justifying them?
Dr. Grace Lee: The current schedule proposed by HHS is described as defaulting to the childhood immunization schedule used in Denmark. But when you look at what other countries recommend, you see that the U.K., Canada, and Australia, for example, routinely recommend sixteen out of the eighteen available vaccines or monoclonal antibodies for protection. Denmark is actually a low outlier among the countries cited in the report.
Another point is that HHS has stated an interest in requiring double-blind, placebo-controlled trials to evaluate vaccine risks — even though hundreds of millions of doses have been administered to children worldwide, and the health benefits are both tremendous and demonstrable.
The other major issue is process. There is a unilateral focus on vaccine safety without a commensurate focus on vaccine benefits. That imbalance adds to the confusion.
Mina Kim: And you feel that’s problematic?
Dr. Grace Lee: Yes. Many of us who care for patients and work in the scientific community rely on data and evidence to guide decision-making. What’s confusing here is that these de-implementation efforts are not based on any new randomized controlled trials or gold-standard evidence showing that contracting disease is safer than being vaccinated.
There’s no evidence demonstrating the efficacy or effectiveness of these changes. In contrast, there’s a very high bar applied to vaccines, with a singular focus on safety — not on the safety of children who may contract these illnesses.
Mina Kim: You chaired the Advisory Committee on Immunization Practices from 2021 to 2023, so fairly recently. The process that led to these recommendations sounds unfamiliar to you.
Dr. Grace Lee: The process has changed significantly over the past six months. For listeners who may not be familiar, the Advisory Committee on Immunization Practices is a federal advisory committee that makes recommendations to the CDC director on childhood, adolescent, and adult immunization schedules.
The committee reviews data using a formal evidence-review process called GRADE, along with an evidence-to-recommendations framework. In June 2025, the entire federal advisory committee was replaced within forty-eight hours. Then in August, the CDC director — who had been Senate-confirmed just twenty-nine days earlier — was fired for refusing to endorse changes to the immunization schedule before committee deliberations.
As a result, the role of the committee has changed, and so has the nature of the presentations. In recent meetings, we did not see disease-area experts presenting evidence. Instead, a trial lawyer who had previously represented anti-vaccine groups served as the sole expert presenting evidence on the childhood and adolescent immunization schedule.
Mina Kim: Maria, we heard Dr. Lee say that the U.S. used to be closely aligned with countries like Canada and Australia, and is now more closely resembling Denmark’s vaccine schedule. You looked into this. Is Denmark an appropriate model for the U.S.?
Maria Godoy: No, it’s not. Experts told me it’s like comparing a yacht to a kayak — they’re just completely different situations.
Denmark has a population roughly the size of Wisconsin. It’s far less heterogeneous in terms of income, race, and ethnicity. They have universal health care and close to a year of paid maternity leave. All of these factors create a very different environment for protecting children’s health, especially newborns.
That means Denmark can make different cost-benefit calculations. They’re also paying for these vaccines. If a newborn is home with a parent for the first year, they’re not exposed to as many pathogens as a child in daycare, where multiple infants bring illnesses from home. And if a child does get sick, they have access to free health care in a way that many families in the U.S. do not.
Experts told me you really can’t compare the two systems. And as Dr. Lee noted, the focus in Denmark and other countries is not on questioning vaccine safety — it’s about cost-benefit analysis within their health systems. Everyone agrees the vaccines are safe, even if they’re not all on the routine schedule.
It’s also important to note that many other European countries recommend fifteen or more vaccines. The U.S. wasn’t a major outlier before — Denmark was. Now the U.S. has joined Denmark on the low end.
Mina Kim: You’ve also spoken with pediatricians about how they’re responding to these changes. What are you hearing?
Maria Godoy: There’s a lot of exhaustion and frustration. Vaccine hesitancy isn’t new — it’s been around for a long time — but it’s grown more rapidly since the pandemic.
I want to stress that parents want to do the best for their children. But if you’re not paid to study this all day, you’re relying on headlines and social media, and there’s a lot of confusion.
I’ve talked to pediatricians just in the past week who said parents came in frightened and terrified because they didn’t know what the right thing to do was. They’re hearing they may not need certain vaccines, while also hearing misinformation that vaccines aren’t safe — claims that are not supported by science.
Pediatricians are spending more and more time addressing these concerns, and that’s incredibly time-consuming. Doctor visits already allow limited time with families, and this has been a growing issue for months. Now, some of that mixed messaging is coming from the top — from federal health officials — which makes their jobs even harder.
Mina Kim: We’ve been talking with Maria Godoy, health correspondent for NPR, and Dr. Grace Lee, professor of pediatric infectious diseases at Stanford Medicine. And we’re talking with you, our listeners.
I want to hear your questions and reactions to the changes to the vaccine schedule — and whether these new guidelines will influence decisions about what shots your kids get. What do you think about the direction of national health policy under RFK Jr.? He’s also issued new guidelines related to dietary choices, and we’ll get into those after the break.
Stay with us. This is Forum. I’m Mina Kim.
